WIRELESS CAPSULE ENDOSCOPY IN CLINICAL PRACTICE

Abstract

Large multi-center clinical trials have demonstrated the utility of Wireless Video Capsule Endoscopy (WCE), in the detection of small bowel pathology. How practical and useful is WCE in a GI practice? Methods: 138 patients were referred for WCE between January 2003 and June 2004. 80 patients were studied. The group was 60% (48) female, 40% (32) male; average age 58 (range 11–86). All patients underwent EGD and Colonoscopy, most Ileoscopy and Small bowel series, all within 1 year prior to their study. All studies were reviewed by 4 independent readers. Results: 48 patients had Obscure GI blood loss (30 occult; 18 overt); 13 had Indeterminate Colitis; 9 had diarrhea and abdominal pain; 10 had suspected small bowel polyposis. Reading times: 40 to 80 minutes. Average Small bowel transit was (SBT) 245 minutes. The capsule reached the cecum in 91% of the cases. 3 patients had markedly prolonged SBT (all with diffuse small bowel Crohn's). In 1 patient, the capsule was retained (to date-4 months; diagnosis-Crohn's). Small bowel pathology was detected in 80% of the patients. Vascular Ectasias were detected in 29 patients, Small bowel ulcers were detected in 26 patients; the diagnostic yield for obscure occult bleeding was 56.6%, and for obscure overt was 66.6%. 18 definite sites of bleeding were detected. 3 patients appeared to have active bleeding (1 from VE, 2 from gastric erosions). In 11 patients, findings were consistent with Crohn's disease. 8 patients had findings consistent with Celiac Sprue (one in the setting of Crohn's). 10 patients had findings attributed to NSAID use. 13 patients had non-specific inflammatory changes. 1 patient had numerous small bowel polyps (diagnosed Gardner's syndrome). 3 studies were non-diagnostic secondary to gastric retention of the capsule. These findings prompted a change in medical management in 70%. 10 patients underwent small bowel enteroscopy for cauterization or biopsy. 1 patient had a right colectomy with ileal resection secondary to bleeding VE. Conclusion: WCE maintained a high diagnostic yield in clinical practice. WCE was practical, and led to significant therapeutic gain.